Are High-Dose Opioid Prescriptions to Blame for Overdoses?

No clear cut-off dosage level to curb overdosing rates was identified

A new study has found that 71% of patients who overdosed on opioid prescription painkillers were given higher prescriptions than similar patients who had lower dose prescriptions. However, no specific morphine-equivalent mg (MEM) was identified to differentiate patients at risk and those not at risk of overdose.

Researchers from the University of Michigan and VA Ann Arbor studied the records of 442 veterans; 221 who died from accidental opioid overdoses and 221 veterans who also received opioid painkillers but did not overdose. The average dose of those who overdosed was significantly higher at 98.1 MEM daily, compared to 47.7 MEM daily of those who did not die (P<0.001). This gap did not decrease by much when patients who had super high dose prescriptions (>300 MEM daily), were excluded.

Although the average dose associated with overdoses was much greater, some overdose victims had prescriptions under 50 MEM daily. The researchers deduce that this may be due to the many overdose dangers that exist, such as patients who take more than prescribed to combat a flare-up or patients who take alcohol and lose track of when their last dose was.

Although no cut-off dosage level was identified in the study, the authors suggest that lowering the recommended dosage threshold below the daily 100 MEM used in many guidelines could potentially benefit patients who are at risk of overdose. “Our findings suggest that changing clinical practices to avoid escalating doses for patients with chronic pain could make a major difference in the number of patients who die,” said Amy Bohnert, MHS, PhD, first author of the study.